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THE OJNA JOURNALIssue 4 | Spring 2019

Men in Nursing & Surgical NursingHonesty in Healthcare

Surgical Scrubs:Then and Now

The Gender Wage Gap in Nursing

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TABLE OF CONTENTS:

MEN IN NURSING & SURGICAL NURSINGTHE GENDER WAGE GAPIN NURSING page 5

SURGICAL SCRUBS: THEN & NOW page 9

HONESTY IN HEALTHCARE page 11

Dear Nurses,

This is the first issue where we have de-cided to feature two topics in nursing as opposed to a single focus. Approximately 9-10% of the nursing workforce are men, and while we do not have demographic data on OJNA members, we are pleased to have many, many men as part of our nursing organization. We are also proud that we remain a frum nursing organiza-tion while endorsing, encouraging, and forging alliances between all nurses, men and women. The professional and colle-gial discussions held on our OJNA Face-book forum are due to the professional-ism and respect exhibited by all members. We continue to learn from one another, and frum men in nursing have much to offer in terms of their experiences and perspectives. We have decided to feature some of our male nurses, and we appreci-ate those who agreed to share their thoughts and stories with us.

From a clinical and educational perspec-tive, the journal team voted to feature surgical nursing, considering that it is relevant to many nurses in surgical and non-surgical fields: pre-op, peri-op, post-op, PACU, labor and delivery, medical-surgical, and even intensive care. All pro-viders in these units and fields encounter patients who have undergone surgery. We’ve chosen some research to profile, from the rare and obscure to the highly relevant.

We hope you enjoy this Spring 2019 edi-tion of The OJNA Journal! As always, please feel free to send your thoughts or questions to OJNAJournal@gmail.com.

Best,

Blima Marcus, DNP, ANP-BC, RN, OCN

Editor-in-Chief, The OJNA Journal

OJNA LEADERSHIP

Mission:

Th e mission of Th e OJNA Journal is to

• Provide timely news and research updates

• Relay evidence-based research

• Share OJNA news and updates

Editor-in-Chief:

Blima Marcus, DNP, ANP-BC, RN, OCN

Managing Editor:

Sarah Bracha Cohen, MS, RN

Editorial Board:

Tobi Ash, MBA, BSN, RN

Batsheva Bane, BSN, CNM, RN

Tami Frenkel, BSN, RN

Shaindy Lapides, BN, RN

Tzippy Newman, BSN, RN

Board of Directors:

Shevi Rosner, MSN, RN-C, President

Toby Bressler, PhD, RN, OCN, Vice President

Mara McCrossin, MSN, NP, Treasurer

Chaya Milikowsky, MSN, AG-ANP-C, Secretary

All advertising is subject to the approval of OJNA.

OJNA Mission Statement:

Th e Orthodox Jewish Nurses Association was founded in 2008 by Rivka Pomerantz, BSN, RN, IBCLC. It seeks to provide a forum to discuss profes-sional issues related to Orthodox Jewish nurses and arrange social and educational events. We strive to meet the needs of our members, promote profes-sionalism and career advancement, and be a voice for Orthodox Jewish nurses across the world.

Contact us at OJNAJournal@gmail.com

Follow us!

� @jewish_nurses

� Orthodox Jewish Nurses Association (OJNA)

� @JewishNurses

Editor's Note

page 2 OJNA EDITORIAL MESSAGE

page 3 ISSUE AT A GLANCE

page 4 RESEARCH RECAP

page 5 FEATURE ARTICLE

page 11 MEMBER MILESTONES

page 12 OJNA EVENTS

page 14 NURSES TO KNOW

page 15 CAREERS TO CONSIDER

page 18 MUSINGS

page 19 NURSES OF OJNA RECOMMEND

page 19 JOB POSTINGS

page 23 OJNA NEWS

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If I get it right, I can

preserve his dignity

amidst degradation.

Psychological issues

surrounding facial

transplants are related

to identity, new

facial appearance,

mental health issues,

substance abuse, social

integration, and impact

on family members.

page 5

How could I reason with

someone who was deliri-

ous and confused when

he tried to yank out his

IVs and Foley catheter in

order to totter, on

unsteady feet, towards

the exit?

page 22

It appears that the gender pay disparity for nurses is an

issue that cannot be explained by education, certifi cation,

hours worked, location, or salary negotiation.

UP UNTIL 1982, MALES WERE NOT PERMITTED TO ATTEND SOME STATE SPONSORED NURSING SCHOOLS.

Bastien recognized the need for

a tool and staff training to pick

up on signs of abuse and

neglect consistent with hu-

man traffi cking, such as con-

fl icting stories, fake IDs, unex-

plained bruises, and not being

allowed to answer questions. page 5

The average turnover time to prepare the OR between

cases was 20 minutes for the OR playing slow music

and 17 minutes for the OR playing fast music.

With regard to lying to patients about their prognosis, 3 times as many physicians felt that it was ok to lie at times than did their APRN colleagues (24% versus 8%).

page 11

NEVER LIKED THE TERM “MALE NURSE” ANY MORE THAN I

WOULD IMAGINE A WOMAN WOULD LIKE TO BE REFERRED TO AS A

“FEMALE DOCTOR” OR “FEMALE COP.” page 14

page 18

THIS ISSUE AT A GLANCE:

page 5

page 4

page 5

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Musical Interludes in the OR

Th ere are currently 13 facial trans-plant (FT) centers in the United States, and only fi ve of them have actual experience performing these procedures. Th is means that patients undergoing a facial trans-plant will likely be traveling long distances from home. Transplant patients require long-term follow up to ensure adherence with immu-nosuppressive regimens, and to be monitored for signs and symptoms of rejection, infection, malignancy, diabetes, and other complications. Oft en, follow up is performed by local primary care providers or nephrologists who monitor the patient’s laboratory tests and look for clinical signs and symptoms of adverse events. However, the in-terdisciplinary team required for FTs includes speech and swallow therapy, physical and occupational therapy, orthodontics and maxil-lofacial prosthetics, and extensive psychological and psychiatric care. Psychological issues surrounding FTs are related to identity, new

facial appearance, mental health issues, substance abuse, social integration, and impact on fam-ily members. When considering a candidate for a FT, communication with local health care providers will ensure the best possible care and outcome. Th e authors consider the likelihood that they will need to train local healthcare providers to care for FT recipients. Foreseeable concerns related to transferring follow-up care to local providers include: lack of data collection for the FT team, loss of experience for the FT team, and relationship tran-sitions for the patient when switch-ing from the FT team to a local team. Th ese concerns may be miti-gated by continued and transpar-ent communication between the FT team, the patient, and the local providers who will be assisting with long-term follow up [1].

References:[1] Rifk in, W. J., Manjunath, A., Kimberly, L. L., Plana, N. M., Kantar, R. S., Bernstein, G. L., ... & Rodriguez, E. D. (2018). Long-distance care of face transplant recipients in the United States. Journal of Plastic, Reconstructive & Aesthetic Surgery.

RESEARCH RECAP Blima Marcus, DNP, ANP-BC, RN, OCN & Tziporah Newman, BSN, RN

Long Distance Care for Patients with Facial Transplant

Hospital-acquired pressure injuries (HAPI) account for $11 billion in cost in direct and indirect costs, and a 2016 study found that they increased hospital costs by 44% per stay. Long surgeries may cause HA-PIs since there is limited recourse in off -loading the pressure during op-erations. An alternating-pressure (AP) overlay was developed which mimics the off -loading of pressure achieved during turning and po-sitioning patients, however, using only a minimal 1-inch of infl ation in various zones at diff erent times. A team of researchers evaluated whether this micropressure system was successful at avoiding pressure ulcers in surgical patients. Inclu-sion criteria included 392 neuro-surgical patients whose procedures were anticipated to take longer than two hours. Th e participants

were randomized to usual care or the experimental (AP) group. At fi ve days post-op, the existence of pressure ulcers was evaluated using the Braden Scale. While 18 of the control patients had developed a HAPI, zero of the patients who had used the AP overlay had developed a pressure ulcer. Use of the overlay was not associated with any peri-operative complications, increased surgery time, or wound complica-tions. Th e Association for peri-Op-erative Registered Nurses (AORN) provides recommendations on bundled care to prevent operative pressure ulcers, and endorses ad-ditional research on comparative eff ectiveness. [1].

References:[1] Joseph, J., McLaughlin, D., Darian, V., Hayes, L., & Sid-diqui, A. (2019). Alternating pressure overlay for preven-tion of intraoperative pressure injury. Journal of Wound, Ostomy and Continence Nursing, 46(1), 13-17. doi:10.1097/won.0000000000000497

Pressure Ulcers in the OR Since the early 1900s, the use of music in operating rooms (OR) has transitioned from experimental to routine. Beginning in 1914, when an anesthesiologist put on a pho-nograph to calm the patients, to 1929, when Duke University hospi-tal offi cially installed speakers and radios throughout the facility, the recognition of music as therapy and a mood changer has been shown to be evidence-based. One recent study decided to examine how music in the OR can have benefi ts beyond surgical team congeniality and pa-tient relaxation: the authors decided to check whether the tempo of music played during surgery had an eff ect on OR preparation time [1]. For one week, a playlist with a fast tempo (121.4 beats per minute) played in the OR. Th e next week, a playlist with a slower tempo (108.6 beats per minute) played. During these two weeks, the staff remained the

same, and the procedure didn’t vary: uncomplicated cataract surgery was performed. Th e average turnover time to prepare the OR between cases was 20 minutes for the OR playing slow music, and 17 minutes in the OR playing fast music. Th is three-minute reduction in prepara-tion time translates into a signifi cant savings: at a rate of $62 dollars per minute [2] of OR costs, multiplied by at least 10 cases per day, translates into a savings of $483,600 per OR per year. More research should be done to confi rm these fi ndings. Sav-ings of nearly $500,000 per operating room per year is well worth listening to Ke$ha.

References:[1] Mosaed, S., Vahidi, R., & Lin, K. Y. (2018). Eff ect of music tempo on operating room preparation time. Journal of Periopera-tive Practice. doi:10.1177/1750458918808151[2] Macario, A. (2010). What does one minute of operating room time cost? Journal of Clinical Anesthesia, 22(4), 233-236. doi:10.1016/j.jclinane.2010.02.003

Henry Ford Hospital in Detroit, Michigan has instituted a human traffi cking screening tool in their Emergency Department that has saved 17 traffi cking victims over the last year [1-3]. Michigan has a high incidence of human traffi cking in part due to its highway accessibility and the annual North American International Auto Show [1,3]. Th e protocol was created by Danielle Bastien, RN, DNP, FNP-BC, an emergency department nurse, as a project for her doctoral degree, and it was quickly instituted as hospital policy [1]. Bastien recognized the need for a tool and staff training to pick up on signs of abuse and neglect consistent with human traffi ck-ing such as confl icting stories, fake IDs, unexplained bruises, and not being allowed to answer questions [1-3]. According to the new protocol, the patient is fl agged upon initial triage based on these signs, which then alerts the primary nurse to continue with more specfi c questions [1]. Th e patient is off ered assistance and if he/she accepts, he/she is off ered housing and basic necessities [1-3]. If the patient is not ready to accept help, he/she is are provided with a personal item that has a hotline number on it [3]. Nurses around the country can take a stand against human traffi cking by urg-ing implementation of protocols similar to Bastien’s. Continuing education with a focus on traffi cking, knowing state statistics, and knowing the number for the National Human Traffi cking Hotline are a few other ways to help traffi cking victims [2].

References:[1] Adkins, J. (2019). Henry Ford nurse steps up to fi ght human traffi cking. Retrieved from https://www.henryford.com/news/2019/01/henry-ford-nurse-steps-up-to-fi ght-human-traffi cking[2] Brusie, C. (2019). Nurse practitioner student creates screening to identify human traffi cking victims. Retrieved from https://nurse.org/articles/nurse-creates-human-traffi cking-screening/[3] Knowles, M. (2019). 17 human traffi cking victims fl agged by Henry Ford nurse’s screening test. Retrieved from https://www.beckershospitalreview.com/quality/17-human-traffi cking-victims-fl agged-by-henry-ford-nurse-s-screen-ing-test.html

Traffi cking

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IntroductionOn June 10, 1963, President John F. Kennedy signed the Equal Pay Act of 1963 to abolish wage dispar-ity based on sex [1]. Th e law states in part that no employer may dis-criminate on the basis of sex, and that employers must pay wages to employees for equal work; for work that requires equal skill, eff ort, and responsibility; and for work per-formed under the same work con-ditions [1].

Disparity in pay equity between male and female workers for most jobs could be explained by racial and occupational segregation, ac-cess to education, bias against work-ing mothers, ageism, and disability for many professions [2]. However, 55 years aft er the act, pay inequality persists in the nursing profession, with higher salaries for male regis-tered nurses (RN) [3]. Th e prover-bial glass ceiling eff ect that stymies the women’s movement upward in male dominated professions to

achieve greater professional and fi -nancial success appears to work as a glass “escalator” eff ect in nursing [4]. Male nurses progress and have increased salaries more than their female counterparts in a female dominated profession [4].

Female and Male Nursing in the PastPrior to the creation of asylums, sanitariums, and hospitals, the home was the center of health care in the United States. Virtually all at-home nursing was done by women [5]. Men traditionally provided nursing care in religious orders (as monks) or as medics in the military [5].

Th e Civil War was the fi rst histori-cal event where both women and men provided nursing care to sol-diers outside of the home—they provided care on the fi eld and in fi eld hospitals [5]. Male nurses also served in the Spanish American War, but as with the Civil War, once the wars were over, they returned to

their businesses or farms [5]. At the turn of the century, the U.S. popu-lation increased dramatically with millions of new immigrants into the country [5]. Th ese individuals came with extremely limited resources and unrealistic expectations of “streets paved with gold” [5]. Th ese huge shift s in the population result-ed in economic problems and major health issues [5]. Housing short-ages, poor sanitation, signifi cant morbidity and mortality, and new social problems characterized the beginning of the 20th century [5].

Rapid modernization, industrial-ization, and the population relo-cation from rural to urban areas changed the way sick individuals received care [5]. No longer able to rely on family for caregiving, sick individuals would go to hospitals that were established to serve those without the resources to provide for their own care [5]. As hospitals proliferated throughout the United States, so did the need for nurses to

deliver care [5].

At the very beginning of the 20th century, nursing schools grew exponentially and were mostly associated with specifi c hospitals [5]. Hospital nurses were all assumed to be female, and they both lived and worked at these hospitals [5]. Female nurses were generally ages 25 to 35, forbidden to marry during their nursing careers, and lived lives similar to those of nuns [5]. Nursing students were not paid and were a source of free labor [5]. Despite these harsh conditions, nursing continued to grow as a desired occupation for women [5]. Th ere were very few nursing schools that ad-mitted men—the University of Pennsylvania was one of the fi rst of approximately nine schools for male nurses [6]. It was also

the fi rst nursing school headed by a man, Leroy N. Craig [6]. Th is all male nursing school was dissolved in 1965, having graduated 551 male nurses [6].

From 1901 until 1955, only females could serve as nurses in the U.S. Armed Forces [7]. Th e Bolton Act, signed by President Eisenhower, gave males the right to work as mili-tary nurses [8]. Up until 1982, males were not permitted to attend some state sponsored nursing schools [9]. Justice Sandra Day O’Connor wrote the opinion of Mississippi Univer-sity for Women v. Hogan that ruled that Mississippi University’s single sex admission policy for nursing school for women only violated the Fourteenth Amendment [10].

When World War I began, there was a need for skilled nurses over-seas. Approximately 23,000 female nurses served for the United States during the war, providing excep-tional care overseas and at home for the armed forces [7]. Th ere were no male nurses in the military, but men worked as nurses in the United States [7]. By 1930, male nurses represented less than two percent of all nurses in the United States, and they left nursing once they found better-paying occupations [7].

World War II transformed the nurs-ing profession in the United States. All of the 59,000 Army Nurse Corps nurses and 18,000 Navy Nurse Corps nurses were female, with no men allowed in [7]. In 1950, there were 415,439 female nurses and 9,489 male nurses in the United States, still only two percent of the workforce [9]. Most male nurses worked in mental asylums or pro-vided care to male patients [9]. Male nurses were fi nally permit-ted to enter Army or Navy Nursing Corps in 1955 [7].

As the hospital-based health care

Pay Inequity for Female and Male NursesTobi Ash, MBA, BSN, RN

(continued on following page)

Current Statistics of Female and Male Nurses at Work Today

There are approximately 3.5 million professionally active nurses in the United States today [10]. About 2.82 million are female and 338,271 are male [10]. Female nurses have an average age of 43.8 years, and male nurses average at 42.9 years of age [10]. The most common race is white [10].

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system modernized, nurses had to handle far more complex and techni-cal tasks. Nursing education kept pace, and by the 1960s, nursing opened up educational and professional opportunities to all [9]. Th ere was no more discrimination by gender or race [9]. At this time, there was expan-sion in nurse specialization with nurse practitioners and intensive care unit nurses providing specialized care [9].

Current Statistics of Female and Male Nurses at Work Today Th ere are approximately 3.5 million professionally active nurses in the United States today [11]. About 2.82 million are female and 338,271 are male [11]. Female nurses have an average age of 43.8 years, and male nurses average at 42.9 years of age [11]. Th e most common race is white [11].

Current Research on Nursing SalariesAlthough nine out of 10 nurses are female, male nurses earn higher sala-ries [3]. Th is pay gap has been consistent for the past 25 years [3].

In a 2015 study published in the Journal of the American Medical As-sociation, Dr. Muench and her co-authors examined two large U.S. data sets of nurse salary earnings [3]. Th e National Sample Survey of Regis-tered Nurses looked at 20 years of responses from almost 88,000 nurses from 1988 to 2008 [3]. Th e American Community Survey examined 206,000 responses from 2001 to 2013 [3].

For both studies, and in each year studied, male nurses earned more than female nurses. Th e unadjusted pay gaps ranged from $10,243 to $11,306 from one survey and from $9,163 to $9,961 in the second survey [3]. In-hospital male nurses had a pay gap of $3,783, while outpatient male nurses earned $7,678 more as compared to female nurses [3]. Male nurses outearned female nurses in virtually every specialty—the gap for

chronic care was $3,792, with an astonishing $17,290 gap for certifi ed registered nurse anesthetists (CRNA) [3].

Another recent study, the 2018 Nursing Salary Research Report, sur-veyed 4,500 nurses in all 50 states and U.S. Territories [12]. Th e data showed that male nurses earned an average of $79,688 annually and fe-male nurses about $73,090—a gap of more than $6,000 per year [12].

Th ere are several factors that may aff ect the gender gap in nursing wages. Th ese include geographic location, certifi cation and education, hours worked and overtime, and salary negotiation [3].

Nurse LocationTh e old adage, “location, location, location” rings true. Nurses’ salaries vary by region and state. Nurses in California earn close to $50 an hour, for an average annual salary of $102,700 [13]. Nurses in Alabama, Ar-kansas, Iowa, Mississippi, and South Dakota earn an average of $28 an hour, for an average annual salary of $57,500 [13]. Nurses who work in Puerto Rico, an unincorporated territory of the United States, earn an average of $16.65 an hour, for an annual salary of $34,630 [13].

Male nurses are more willing to relocate to regions or states based on higher paying salaries [12]. On average, male nurses work more hours than female nurses [12]. Males are also more willing to change jobs for higher salaries—54% of male nurses were willing to change jobs within the next three months as compared to 45% of female nurses [12].

Education and Certifi cationTh e Nursing Salary Research Report survey shows that additional edu-cation and certifi cation narrowed the pay gap between male and female nurses. Male certifi ed nurses made an average of $1,252 more than a fe-male certifi ed nurse [12]. Close to 50% of the survey respondents stated that they were actively pursuing certifi cation, education, or training to raise their salaries [12]. Of the 50%, a greater percentage of male nurses (56%) were interested in additional education and certifi cation [12]. Male nurses also tended to choose nurse specialities rather than remain as staff nurses, and the top 10 paying nurse specialities paid signifi cantly more than staff nurse salaries [14].

Hours WorkedTh e Medscape RN/LPN Compensation Report 2017 surveyed over 5,000 registered nurses to compare male and female nurse salaries [15]. Male nurses had higher annual gross incomes, whether paid by the hour or salary. Hourly pay was an average of $37 both for male and female nurses. Using this average hourly salary, male nurses made an average of $84,000 a year, while female nurses averaged $80,000. Th e overall higher average pay for male nurses paid hourly could be due to pay diff erentials, overtime, location, or certifi cation [15]. However, salaried male nurses made more than $8,000 more per year than female nurses in the same position [15].

NegotiationAccording to the Nursing Salary Research Report, the number one compensation factor across the board for all nurses was salary, fol-lowed by medical insurance [12]. Male nurses negotiated for salary compensation 43% of the time, while only 34% of female nurses re-ported doing so [12].

Outside the United StatesA partial explanation for the pay disparity for male and female nurses in the United States can be explained by salary diff erentials based on loca-tion, educational and certifi cation choices, and the ability for nurses to negotiate salary [15]. Dr. Ulrike Muench, one of the foremost research-ers for the pay equity gap for female and male medical professionals,

PAY INEQUITY FOR FEMALE AND MALE NURSES(continued from previous page)

(continued on following page)JAMA March 24/31, 2015 Volume 313, Number 12 p.1265

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recently examined nursing pay gaps in Germany [16]. Similar to the Unit-ed States, most nurses in Germany are female, with males accounting for 10-15% of nurses [16]. Nurses account for the largest workforce in the European Union, with about 700,000 nurses active in the continent [16]. German nurses usually attend a vocational school that follows a country-wide curriculum, rather than enroll in bachelor programs [16]. Addi-tionally, they earn wages that are regulated and developed by a collective agreement with known pay scales for overtime, holiday, and advancement [16]. Overall, nurses in Germany are far more homogenous than nurses in the United States [16]. However, German male nurses outearned German female nurses. Th e unadjusted monthly earnings for German male nurses was 30% higher than female nurses, with €700 more ($781) per month [16]. Aft er fully adjusting using analyses of hours worked, additional edu-cation, nursing and other previous job experience, and years at the medi-cal facility, German male nurses still earned almost 10% more than their female co-workers—about €260 ($300) a month more [16].

It appears that the gender pay disparity for nurses is an issue that can persist even aft er adjusting for education, certifi cation, prior experience, hours worked, location, or salary negotiation, even in a society and coun-try where nursing follows a more homogenous course [16].

Comparisons A 2017 study examined wages for male and female employees in two of the “pink professions”—or professions that have been traditionally female in nature: nursing and teaching [17]. Salaries of more than 427,000 nurses and 960,000 teachers for a 13 year time span were examined [17]. Male nurses and teachers were paid higher salaries than females: male nurses averaged about 28% more than female nurses and male teachers earned about 20% more than female teachers [17]. Education is touted as a way to increase wages in all professions. However, even if women do pursue additional certifi cation and education, they still earn less than men [2].

Two-thirds of the earnings gap can be explained by diff erences in edu-cation, certifi cation, specialization, experience, hours worked, work po-sition or role, and geographic location [15]. Male nurses may seek cer-tifi cation or pursue higher education, take higher paying shift s (with

diff erential), work in an urban center or inpatient area (that pays more), or change jobs to one with higher pay [17].

However, this still leaves a one-third gap in the understanding of the pay disparity between male and female nurse salaries [18]. If both male and female nurses make the same hourly wage, and female nurses have greater experience than male nurses, why do males earn more, even aft er adjust-ing for all of the above factors [18]?

Research of 87,890 registered nurses with data pooled for 20 years (1988-2008), with nurses working full time (35+ hours per week for 50 weeks) looked at career aspiration and motivation, workplace experience, time out for child rearing, and physical capability [18].

Career aspiration and motivation was determined by geographic location and how many nurses changed jobs and job location. Male nurses moved more and changed jobs more frequently than female nurses [18]. Males were also more likely to change jobs for higher pay [18].

Th e data in this study revealed that male nurses were older when they completed their RN training and had fewer years of nursing experience as compared to females [18]. More males were in nursing’s highest pay-ing specialities (psychiatric, critical care, nurse anesthetist) than females (36% vs. 29%) [18]. More males nurses were in higher paying positions, such as administration and senior academics, than females (14% vs. 9%) [18]. What is troubling is that female nurses aged 30 years or younger, with two years and under of work experience, earned $5,265 less than their male counterparts in the exact same position [18].

Th e idea that there is a “motherhood penalty” for female nurses does not hold true. Female nurses aged 40-45 with no children at home earned $6,207 less per year than male nurses in the same age cohort without chil-dren at home [18]. Males earned more than females, even in less physi-cally demanding roles [18]. Th ere was a signifi cant pay gap in all areas for male and female nurse specialty roles with the same education, clinical experience, and hours worked [18]. As the role of nurses continues to expand in the provision of healthcare, there needs to be a serious exami-nation of the disparity of female and male nurse pay.

PAY INEQUITY FOR FEMALE AND MALE NURSES(continued from previous page)

(continued on following page)

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NURSE PRACTITIONERS

A recent 2017 survey looked at 6,591 nurse practitioners working a minimum of 35 hours per week, and analyzed salary and gender [19]. Male nurse practitioners earned close to $13,000 more per year than female nurse practitioners after adjusting for speciality, practice type, and location. Male nurse practitioners earned more than females across all specialities [19].

C losing the GapPay equity assessments are needed to identify and ameliorate pay inequality. Education, ac-creditation, location, and experience do mat-ter, but a disparity in salary continues to exist. Nursing is the largest healthcare occupation in the United States [20]. A combined eff ort of federal and state governments is needed to address pay inequity for nurses. Annual re-view of nursing compensation is imperative to ensure greater transparency, open pay poli-cies, and equity adjustments.

References:[1] U.S. Equal Employment Opportunity Commission. (1963). Equal Pay Act of 1963. Retrieved from http://www.eeoc.gov/eeoc/history/35th/thelaw/epa.html

[2] American Association of University Women. (2018). Th e simple truth about the gender pay gap. Retrieved from https://www.aauw.org/aauw_check/pdf_download/show_pdf.php?fi le=Th e_Simple_Truth

[3] Muench, U., Sindelar, J., Busch, S. H., & Buerhaus, P. I. (2015). Salary diff er-ences between male and female registered nurses in the United States. JAMA, 313(12), 1265-1267. doi:10.1001/jama.2015.1487

[4] Williams, C. L. (1992). Th e glass escalator: Hidden advantages for men in the "female" professions. Social Problems, 39(3), 253-267. doi:10.2307/3096961

[5] D’Antonio, P. O. (1993). Historiographic essay: Th e legacy of domesticity: Nursing in early nineteenth-century America. Nursing History Review, 1(1), 229-246. doi:10.1891/1062-8061.1.1.229

[6] Penn Medicine. (n.d.). History of Pennsylvania Hospital-historical timeline: School of nursing for men 1914-1965. Retrieved from http://www.uphs.upenn.edu/paharc/timeline/1901/tline26.html

[7] Sarnecky, M. T. (1999). A history of the U.S. Army Nurse Corps (p. 297). Phila-delphia, PA, PA: University of Pennsylvania Press.

[8] D'Antonio, P. (2002). Nurses in war. Th e Lancet, 360, S7-S8. doi:10.1016/s0140-6736(02)11798-3

[9] D’Antonio, P., & Whelan, J. C. (2009). Counting nurses: Th e power of historical census data. Journal of Clinical Nursing, 18(19), 2717-2724. doi:10.1111/j.1365-2702.2009.02892.x

[10] Mississippi University for Women v. Hogan, 458 U.S. 718 (1982). https://supreme.justia.com/cases/federal/us/458/718/ https://scholar.google.com/schol-ar_case?case=4721441048875094247&hl=en&as_sdt=40006

[11] Data USA. (n.d.) Registered nurses. Retrieved from February 18, 2019 from https://datausa.io/profi le/soc/291141/

[12] 2018 Nurse.com nursing salary research report. (2018). Retrieved from http://mediakit.nurse.com/wp-content/uploads/2018/06/2018-Nurse.com-Sala-ry-Research-Report.pdf

[13] Nurse salary by state 2019. (2019). Retrieved February 18, 2019 from https://nursesalaryguide.net/nurse-salary-by-state/

[14] Papandrea, D. (2017). Fift een highest paying nursing careers [infographic]. Retrieved February 18, 2019, from https://nurse.org/articles/15-highest-paying-nursing-careers/

[15] Stokowski, L. A., Yox, S. B., McBride, M., & Berry, E. (n.d.). Medscape RN/LPN compensation report, 2017. Retrieved from https://www.medscape.com/slideshow/2017-rn-lpn-compensation-report-6009118

[16] Muench, U., & Dietrich, H. (2019). Th e male-female earnings gap for nurses in Germany: A pooled cross-sectional study of the years 2006 and 2012. Interna-tional Journal of Nursing Studies, 89, 125-131. doi:10.1016/j.ijnurstu.2017.07.006

[17] Wilson, B. L., Butler, M. J., Butler, R. J., & Johnson, W. G. (2017). Nursing gender pay diff erentials in the new millennium. Journal of Nursing Scholarship, 50(1), 102-108. doi:10.1111/jnu.12356

[18] Muench, U., Busch, S.H., Sindelar, J., Buerhaus, P.I. (2016). Exploring expla-nations for the female-male earnings diff erence among registered nurses in the United States. Nursing Economics, 34(5), 214-23. PMID: 29975036.

[19] Greene, J., El‐Banna, M. M., Briggs, L. A., & Park, J. (2017). Gender diff er-ences in nurse practitioner salaries. Journal of the American Association of Nurse Practitioners, 29(11), 667-672. doi:10.1002/2327-6924.12512

[20] U.S. Department of Labor. Bureau of Labor Statistics. (2018). Occupational employment and wages—May 2018. Page 16. Retrieved from https://www.bls.gov/news.release/pdf/ocwage.pdf

Male Nurse StereotypesMen served as nurses in ancient times in the military and in religious orders. When Florence Nightingale went to Crimea, virtually all care was provided by male orderlies. The dramatic changes in population and the rise of hospitals at the end of the 19th century, moved female nursing to the forefront [1].

In 1901, when the American Nurses Association was founded, only female nurs-es were permitted to serve in the armed forces. This ban against male nurses ended only in 1955 [1]. Many in the armed forces believed that male nurses “had something wrong with them” or were homosexual [1].

There are specifi c challenges that male nurses face. “Male nurses are thought of as “muscle”"; they are there to help lift heavy patients and move heavy equip-ment. Another stereotype of male nurses are that they are not capable of being caring and nurturing. Others may believe that male nurses are failed doctors or are just there to see naked women [2].

Barriers for Male Nurses Today

Most male nurses did not receive information on nursing as a career in high school. There is a distinct lack of male nurse educators and mentors. Even once men decide to enter nursing school, many of them report lack of support for their career choice. Many men report that there is suspicion of their hands-on care for female patients. Male nurses may be shut out of certain clinical settings such as labor and delivery [3].

References:[1] Sarnecky, M. T. (1999). A history of the U.S. Army Nurse Corps (p. 297). Philadelphia, PA: University of Pennsylvania Press.[2] Wojciechowski, M. (2016). Male nurses confronting stereotypes and discrimination: Part 1, the Issues. Minority Nurse. Retrieved from https://minoritynurse.com/male-nurses-confronting-stereotypes-and-discrimination-part-1-the-issues/.[3] Macwilliams, B. R., Schmidt, B., & Bleich, M. R. (2013). Men in nursing. American Journal of Nursing, 113(1), 38-44. doi:10.1097/01.naj.0000425746.83731.16

Nursing Scholarships for MenTo increase the diversity of nursing, there are scholarships available exclusively for male nurses.

HENRY DUNANT SCHOLARSHIP FOR MALE NURSING STUDENTS

Funded by the Henry Dunant Scholarship Committee, this private scholarship of $250 was estab-lished to help undergraduate nursing students who are currently enrolled in an accredited nursing program in the United States and need fi nancial assistance. As its name suggests, the scholarship is awarded specifi cally to male students of any ethnicity who have good aca-demic standing with a cumulative GPA of 2.5 or higher. Applicants are required to provide proof of acceptance in a nationally recognized nursing program and submit a one to two page essay on the history of men in nursing, including the Nobel Peace Prize winner Henry Dunant.

AAMN FOUNDATION SCHOLARSHIPS FOR MEN

https://www.aamn.org/scholarships

AAMN JOHNSON & JOHNSON SCHOLARSHIP

Beginning in 2004, this scholarship has been offering $1,000 to male nursing students based on proven accomplishments. This fund provides twenty scholarships annually, but only when funds

are suffi ciently available. Recipients must maintain a minimum 2.75 GPA and be enrolled in a

pre-RN program.

JADEH MOORE STUDENT NURSE ESSAY CONTEST

The winner of this contest must be a Pre-RN male student and enrolled in a program that will lead to NCLEX-RN eligibility. He will receive $500 for writing the best response to a question posed by The American Assembly for Men in Nursing.

ISTUDYSMART.COM SCHOLARSHIP

This scholarship is geared toward males who are seeking their Associate in Nursing Degree from

Excelsior College through the school’s distance learning program.

Deadline: August 1stContact: Henry Dunant Scholarship for Male Nursing Students15 Roxbury Dr.Littleton, MA 01460(978) 413-4457m.cabotrn@gmail.com

Th e OJNA Journal - Page 9

Seeing someone in a pair of scrubs automatically identifi es them as an individual of the medical profession. Historically, only nurses wore uni-forms. Th ese ranged from regular aprons (think Florence Nightingale) to white caps and fl oor-length gowns, to nuns’ habits, to starched criss-crossed aprons seen through the last two cen-turies, to casual scrubs worn today. Currently, nearly everyone in healthcare wears scrubs, from doctors, to nurses, x-ray technicians, and home attendants. It is the stockpile image of someone involved in healthcare. However, surgical scrubs have been around for less than 100 years.

Scrubs and Gowns

Before the 19th Century, surgeons wore their own clothing while operating [1]. Th ey wore no protective garments, only taking off their coats or rolling up their sleeves [1]. Famous paint-ings, such as Th omas Eakins' 1875 depiction of Dr. Samuel Gross in Jeff erson Medical Col-

lege's surgical amphitheater in Th e Gross Clinic (pictured), demonstrate common practices of the time. Eventually, surgeons began wearing aprons to avoid getting too bloody, still unaware of the risks of infections to themselves and to their patients [1]. In the late 19th century, sur-geons took to wearing full length cotton gowns, described in a letter to Florence Nightingale as “garments of white mackintosh which cover them from chin to toes, and over this a shift —a kind of white cotton surplice with loose sleeves coming to the elbows” [1].

A German surgeon by the name of Gustave Neu-

ber of Kiel is noted to have been the fi rst doc-tor to implement sterile gowns [1]. In 1883, he noticed a reduction in infections of surgical sites with the use of caps and gowns [1,2].

When the use of sterile surgical attire became more widespread, the color white was used since it was considered easier to wash [1]. Eventually, with the invention of electric lights, the white of the scrubs and the bright lights became too tiring for the eyes, so the color was changed to green [1]. In 1914, a San Francisco surgeon, Harry Sherman, stated the color green would help, as it “keeps the surgeon’s eye acute to red and pink” [1]. In the 1950s, when color TV was utilized for taping procedures and teaching medical stu-dents, the color blue became popular as well [1].

Masks

With the combination of increased attention to Lister’s germ theory in the 1800s and the Spanish Flu pandemic in the early 20th century, doctors began wearing cotton masks to protect them-selves from catching diseases from patients [1]. However, it was not until 1926 when a clinical study showed correlations between masks and the reductions of surgical site infections [2]. Aft er that, the use of masks became more wide-spread, but the practice varied from hospital to hospital [2]. In 2016, the American College of Surgeons released specifi c guidelines for surgi-cal attire, including face masks for all operating room staff [3]. While current evidence does not support the likelihood of surgical site infections for masked versus unmasked operating rooms [4,5], the current expected professional attire in-cludes the mask [3].

Gloves

In 1893, Dr. Joseph Bloodgood noticed gloves lead to a reduction in infection rates [1]. He be-

gan to use them, but other surgeons of his era did not like wearing them, as it decreased their sense of touch [1,2]. Oft en, surgeons would re-move their gloves or operate with bare hands [2]. Early gloves were made of cotton or silk, and sometimes coated with paraffi n [2]. Th e fi rst rubber surgical gloves were created in 1889, used to protect the hands of the surgeon from irritat-ing chemicals used during surgery, rather than protect the patient [2]. In 1946, the Ansell Rub-ber Company developed automatic machinery to manufacture rubber gloves, increasing pro-duction, and in 1965, they created the fi rst sterile glove [6]. By 1966, rubber surgical gloves were the standard in the operating room (OR) [7].

Th e beauty of science is in its capacity to evolve, based on evidence. As doctors began to under-stand the relationship between cleanliness, ste-rility, and patient infections, they changed the way they performed surgery. Th e idea of doctors in the 19th century with open surgical theaters and bare-handed manipulation of tissue seems barbaric. A patient going into an OR expects the now familiar sight of the blues or greens and pro-fessionally scrubbed surgeons, nurses and staff .

References:[1] Buicko, J.L., Lopez, M.A., & Lopez-Viejo, M.A. (2016). From formalwear and frocks to scrubs and gowns: A brief history of the evolution of operating room attire. J Am Coll Surg, Surgical History Journal, 1(1), 1-5.[2] Adams, L. W., Aschenbrenner, C. A., Houle, T. T., & Roy, R. C. (2016). Uncovering the history of operating room attire through photographs. Anesthesiology, 124(1), 19-24. doi:10.1097/aln.0000000000000932[3] Fellow, American College of Surgeons. (2016). American College of Surgeons issues statement on appropriate professional attire for surgeons. Retrieved from: https://www.facs.org/media/press-releases/2016/statement-080816[4] Skinner, M. W., & Sutton, B. A. (2001). Do anaesthetists need to wear surgical masks in the operating theatre? A literature review with evidence-based recommendations. Anaesthesia and Intensive Care, 29(4), 331-338. doi:10.1177/0310057x0102900402[5] Vincent, M., & Edwards, P. (2016). Disposable surgical face masks for preventing surgical wound infection in clean surgery. Cochrane Database of Systematic Reviews, (4), Art No.: CD002929. Doi: 10.1002/14651858.CD002929.pub3[6] Ansell. (n.d.). Ansell's history. Retrieved March 1, 2019, from https://www.ansell.com/us/en/about-us/our-history[7] Johns Hopkins Medicine. (2008). Rubber gloves: "Born" - and now banished - at Johns Hopkins. Retrieved from https://www.hopkinsmedicine.org/news/media/releas-es/rubber_gloves_born___and_now_banished___at_johns_hopkins

History of Surgical ScrubsTamar Yehudis Frenkel, BSN, RN

Portrait of Dr. Samuel D. Gross (The Gross Clinic)Source: Thomas Eakins. 1875. Philadelphia Museum

Th e OJNA Journal - Page 10

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Th e OJNA Journal - Page 11

APRN CORNER

Honesty in Healthcare: How Physicians and APRNs Differ in PracticeChaya Milikowsky, AG/ACNP-BC

At times, basic principles of medical ethics seem to be at odds with one an-other. Perhaps telling a patient the ex-tent of his terminal diagnosis will harm him psychologically, and destroy the precious last few months he has to live. Can a provider justify lying to this pa-tient—just a little white lie, , an expres-sion of optimism—so that he and his family can grasp onto the small mea-sure of hope they have left ? Is it right to sacrifi ce some patient autonomy to up-hold the principle of nonmalefi cence?

What about other forms of benevo-lent lying? Can a provider lie to an insurance company to obtain a crucial treatment for a patient? Should a pro-vider lie in this case? Will benefi cence trump justice? Further, how might one feel about less altruistic forms of lying? Should a provider lie to protect a col-league who committed a medical error, if no harm resulted to the patient? Is there any reason to let the patient and family know? What about in a case where a patient was harmed?

Self-serving lies aside, the majority of cases where providers lie—or at least condone lying—occur in situations where there are opposing ethical val-ues. Examples of confl icting principles include protecting a colleague in a near-miss situation when no actual patient harm has occurred, obtaining reimbursement or approval for a medi-cal therapy by lying to insurance com-panies, or promoting patient psycho-logical well-being with untruths about a prognosis.

Studies done in the past decade [1,2] show that the majority of physicians would report the truth when it comes to medical errors. In cases where no actual harm befell the patient, physicians are still likely to report the error, although to a lesser extent than if harm may have occurred. On the other hand, signifi cant percentages of providers feel that lying to obtain medical treatment for a patient may be justifi ed. And as far as lying to patients about prognosis, as one internist noted, “... doctors have hope too” [3].

A 2019 MedScape poll reveals a fasci-nating diff erence in attitudes towards

lying among physicians and advanced practice nurses (APRNs), with physi-cians far more likely than APRNs to be comfortable with untruths [3]. With regard to lying to patients about their prognosis, three times as many physi-cians felt that it was ok to lie at times than did their APRN colleagues (24% versus 8%). Lying to obtain medical treatment was the arena in which both physicians and APRNs felt lying was most acceptable, but physicians were still more likely than APRNs to con-done the behavior (29% versus 23%). Furthermore, 12% of physicians and 4% of APRNs found it acceptable to lie about medical errors.

In addition to attitudes about lying, the MedScape poll further assessed actual incidence of lying among providers. Physicians were more likely to report lying overall—to patients about errors and prognosis, and on behalf of patients to obtain treatments—than APRNs [3].

Whether or not one agrees with the mo-rality of these untruths, and regardless of the potential benevolence inherent in these lies, the data does highlight the integral foundation of honesty embed-ded within the nursing model. Nurses have been ranked the most trusted and ethical profession on the Gallup poll for the last 17 years [4]. Th is recent Med-Scape poll serves to validate this long-held opinion.

References:[1] Everett, J.P., Walters, C.A., Stottlemyer, D.L., Knight, C.A., Oppen-berg, A.A., & Orr, R.D. (2011). To lie or not to lie: Resident physician attitudes about the use of deception in clinical practice. Journal of Medi-cal Ethics, 37(6):333-8. doi: 10.1136/jme.2010.040683[2] Iezzoni, L.I., Rao, Sr, DesRoches, C.M., Vogeli, C., & Campbell, EG. (2012). Survey shows that at least some physicians are not always open or honest with patients. Health Aff airs, 31(2):383-391. doi: 10.1377/hlthaff .2010.1137[3] Frellick, M. (2019). Physicians, nurses, draw diff erent lines for when lying is ok. MedScape Nurses. Retrieved from https://www.medscape.com/viewarticle/908418[4] Brenan, M. (2018). Nurses again outpace other professions for honesty, ethics. Retrieved from https://news.gallup.com/poll/245597/nurses-again-outpace-professions-honesty-ethics.aspx

Chaya Milikowsky is an acute care nurse practitioner who covers the Inten-sive Care Unit at MedStar Montgomery Medical Center at nights. She received both her nursing and nurse practitioner degrees at University of Maryland, Bal-timore. She lives in Silver Spring, Mary-land, with her husband and fi ve children.

TO HAVE YOUR MILESTONE FEATURED IN OUR NEXT JOURNAL EMAIL OJNAJOURNAL@GMAIL.COM

Member Milestones

AVIGAIL KLAGSBRUN, BSN, RN, CCRN, graduated with her ADN from Phillips Beth Israel School of Nursing in May 2012, and with her BSN from Utica College in Au-gust 2014. She currently works in the pediatric intensive care unit (PICU) at St. Peter’s Uni-versity Hospital in New Bruns-wick, New Jersey. In December 2018, she received her Pediatric Critical Care Nurse (CCRN) Certifi cation.

ESTHER LAUBER, BSN, RN, graduated with her BSN from North Park University in Chicago in December 2016. She started a new position working on the pe-diatric transitional unit in Oc-tober 2018 at Maryville Acad-emy in Chicago.

MICHAEL KUPFER, RN, graduated with his ADN in December 2018 from Cuyahoga Community College

in Cleveland, Ohio. He passed his NCLEX in February 2019. He started his fi rst job as a regis-tered nurse in the beginning of March on the epilepsy monitor-ing unit at the Cleveland Clinic.

2019 marks the 20th year of TOBI ASH, MBA, BSN, RN, providing classes on puberty to 5th and 6th grade girls and their

mothers at several of the Jewish girls' schools in Miami. She teaches the girls how to go through these physical, emotion-al, and spiritual changes from a Torah perspective in a fun and approachable way.

Th e OJNA Journal - Page 12

OJNA EVENTS:

Since our last journal publication, OJNA has hosted many events, ranging from our larger Advanced Practice Registered Nurses (APRN)-focused conference, to smaller local events.

Our fi rst APRN-Focused Conference was held in Touro College in Manhattan on January 6 and featured speakers on the topics of antibiotic stewardship, the hala-chic and medical aspects of pregnancy termination, and opioid prescription and addiction. The conference also included a hands-on suturing workshop that was widely appreciated, inspiring requests for future hands-on activities. Of course, as with all OJNA conferences, the opportunity to network and connect with fellow-mind-ed frum nurses was a highlight.

In recent months, we have hosted events for nearly every OJNA Chapter.

South Florida held a networking social event at China Bistro restaurant in October 2018.

The Florida OJNA chapter also hosted a CPR class for men in March.

Cleveland hosted a networking lunch at Jade Restaurant in November 2018.

In January 15, Chicago nurses of the OJNA met at the home of Raina Leon to socialize and learn about the many benefi ts of OJNA membership. Following the event, the Chicago OJNA nurses resolved to create a mentoring partnership with a local Jewish college. They also plan to work on expanding local events to include medical halacha shiurim, with the eventual goal of bringing an OJNA conference to the Midwest.

A few weeks later, Detroit nurses met at the home of Tova Winters to network and discuss ways to navigate their nursing careers, as well as to enjoy a beautiful buffet.

Pittsburgh held its fi rst chapter event in the begin-ning of March with a potluck meet. The 15 nurses who participated felt a sense of warmth and camaraderie, despite ranging from new nurses to more experienced nurses and coming from a variety of backgrounds and nursing specialities.

On April 9, Maryland OJNA members held a networking social event in Silver Spring. Rabbi Eli Reingold, Rosh Kollel in Silver Spring, attended and answered medical halacha questions submitted by attendees.

To create an OJNA Chapter in your area

please contactojnaboard@gmail.com

Th e OJNA Journal - Page 13

OJNA members in Southern California have requested the creation of a chapter in their region, and an initial event is being planned. Keep on the lookout for dates and details!

On March 7, our New-Grad Committee held an educational evening in Brooklyn, featuring Rabbi Jack Abramowitz, notable author of six books and editor at the Orthodox Union. He discussed how nurses—and especially new nurses—can navigate the tricky multicultural healthcare environment, with a specifi c focus on how to explain Orthodox Judaism

to those who are unfamil-iar with its practices and nuances. In addition to the continuing education, CE-approved component of the event, there was a fun ice cream bar and photo-op opportunities.

Th e OJNA Journal - Page 14

NURSES TO KNOW

David M. Pasternak, MBA, MSN, RN-BCNursing Role: Nursing Informatics Specialist

What is your exact title and credentials?I am a nursing informatics specialist. Aft er completing my Asso-ciate of Science in Nursing (ASN) from Middlesex County Col-lege, I went on to earn my Master of Science in Nursing Informatics (MSN) from Rutgers University, and completed my board certifi ca-tion from the American Nurses Credentialing Center (ANCC) in Nursing Informatics. Additionally, I have a Bachelor of Science in Psychology, a Master of Business Administration (MBA) in Com-puter Information Systems, and I am also currently enrolled in a post-MSN certifi cate program for Psychiatric-Mental Health Nurse Practitioner.

Where do you currently work?I work in the Nursing Informatics department at Hackensack Me-ridian Health Raritan Bay Medical Center (RBMC) in New Jersey. I also continue to work as a per-diem staff nurse in a short-term commitment facility.

Can you describe what your responsibilities are at work?Th at is actually not as simple as it sounds because nursing informatics spans so many areas. Essentially, my department (there are three of us) is tasked with supporting the safe and eff ective use of health in-formation technology (IT) to promote and improve clinical decision-making, safety, and positive patient outcomes. Technology that is dif-fi cult to use or poorly designed negatively impacts staff productivity and places patients at risk. We serve as the liaison between the vari-ous clinical areas (not “just” nursing staff ) and IT. We analyze clinical workfl ows and develop the requirements for system enhancements/optimization requests; we may also recommend changes to the work-fl ows, based on our analysis. We are also responsible for testing the technical solutions before they’re released into the production envi-ronment for use by staff . We do a lot of data extraction, analysis, and reporting to support various initiatives, both internal (as in analyzing medication charting errors) and external (such as Meaningful Use at-testation). We also mentor several MSN students each semester dur-ing their Nursing Informatics practicums.We have always been very involved in staff education, but that role escalated recently. In January of 2016, RBMC became part of the Meridian Health network. Later that year, Meridian Health merged with Hackensack University Medical Center (HUMH) to form Hackensack Meridian Health (HMH). Until last year, the various HMH hospitals used multiple charting systems, none of which talk-ed to each other eff ectively, making it diffi cult to share clinical data. Th e decision was made to implement a single electronic medical record—Epic, which was already in use at HUMC—throughout the healthcare network. RBMC became the fi rst hospital to go live with the new system and all staff had to be trained in the new functional-ity. My coworkers and I went through an intensive train-the-trainer program to become Epic Credentialed Trainers and were part of the team responsible for training all of RBMC’s personnel—nurses, physicians, and ancillary staff . We are now getting ready to travel

throughout the rest of the network to train their staff , as each hospi-tal prepares for its conversion to Epic.My coworkers and I also sit on several hospital committees. For example, I represent our department on the Clinical Informatics and Patient Education, Nursing Quality and Practice, Coordinating Council, and Delivery System Reform Incentive Payment (DSRIP)/Readmission Task Force Committees, just to name a few.

How long have you been doing working in your fi eld and was this fi eld your fi rst choice?

Nursing is a career change for me. I spent most of my career in the IT world. I received my RN license in 2012 and started working as a staff nurse on an inpatient psychiatric unit. Because of my IT back-ground, I served as our unit’s representative to the hospital’s Infor-matics Committee. In 2015, I transferred to the Nursing Informatics department. Blending the skills of my old and new professions just seemed to make sense.

How did you hear of/become involved with OJNA?One of my nursing school classmates, Tzippy Newman, recom-mended it to me about a year ago.

Please describe your experience being a male nurse in a predomi-nantly female profession.Well, I have to admit that my female counterparts have a much larger selection of shoes and scrubs than I do, and I am very happy that I didn’t have to fi nd a cap for my pinning ceremony! Seriously, though, I have never liked the term “male nurse,” any more than I would imagine a woman would like to be referred to as a “female doctor” or “female cop.” Even though there have been more men and women crossing the so-called medical gender divide, there is still a tendency in healthcare to refer to nurses as “she/her” and doctors as “he/him.” In nursing school, out of approximately 100 students, I was one of only eight or nine men. Socially, that took some getting used to, since I think we naturally tend to gravitate toward same-gender social groups. During clinicals, I had some pa-tients refuse care because of my gender. Since receiving my nursing license, though, I haven’t really found myself being treated any dif-ferently. I have had several patients address me as “Doctor” and I would simply correct them, saying, “No, I’m the nurse taking care of you today; that woman over there is your doctor.” In short, I am a nurse, not a “murse,” and I am very proud to be a member of the most trusted profession in the United States.

What is something you have done within your workplace that you are most proud of?I was responsible for developing and implementing a system to dis-tribute patient education videos directly to the bedside via our hospi-tal TV network. Th is system was featured prominently in the docu-ment supporting our recent application for Magnet redesignation.

Th e OJNA Journal - Page 15

CAREERS TO CONSIDER

Nursing Informatics SpecialistTziporah Newman, BSN, RN

Job title Nursing Informatics Specialist

Job Description/ Basic Responsibilities [1,2,3]

The International Medical Informatics Association (IMIA) defi nes nursing informatics as the “science and practice [that] integrates nursing, its information and knowledge, management of information, and communication technologies to promote the health of people, families, and communities worldwide.”

• Collaborate in the planning, development, design, implementing, upgrading, and evalu-ation of systems and programs, particularly electronic health records (EHR), that meet the needs of all medical personnel in compliance with health care facility policies and federal laws

• Education and support of computer systems

• Research and analytics

• Quality assurance

• Project management

Educational Requirements [1,3,4]

• RN license

• BSN at a minimum, advanced practice degree, such as MSN in Nursing Informatics, encouraged

• Certifi cation:

Recommended experience [1]

According to the HIMSS 2017 Nursing Informatics Workforce Survey, nurses had anywhere from 1-20+ years of clinical experience prior to transitioning to Nursing Informatics. Nurse Informaticists had the most clinical experience in med/surg, critical care, administration, and emergency department.

Salary [1] Nearly half of individuals surveyed in HIMSS 2017 Nursing Informatics Workforce Survey earned more than $100,000 annually.

Work environment [1,3] Hospitals, health systems, clinics, consulting fi rms, academia, government, ambulatory, long-term care facilities, and IT companies.

Typical Work Schedule 8-12 hour shifts. Additionally, nursing informatics specialists may have to work evenings, overnights, weekends, and holidays in order to be on call if a problem arises.

Job Outlook [3] The growing use of computers and technology in health care leads to an increase in related career opportunities, including nurse informatics who can combine technology and nursing.

Suggested Skills [2,3] • Profi cient computer skills

• Confl ict resolution

• Analytical and critical thinking

• Strong teamwork and communication skills

• Project management

• Problem-solving

References:[1] Healthcare Information and Management Systems Society (2017). HIMSS 2017 nursing informatics workforce survey. Retrieved from https://www.himss.org/sites/himssorg/fi les/2017-nursing-informatics-workforce-full-report.pdf[2] Th e American Association of Colleges of Nursing. (n.d.). Nursing informaticist. Retrieved March 30, 2019, from https://explore

healthcareers.org/career/informatics/nursing-informaticist/[3] Nursing Informatics. (n.d.). Retrieved March 30, 2019 from https://www.registerednursing.org/nursing-informatics/[4] American Nurses Credentialing Center (n.d.) Informatics nursing certifi cation (RN-BC). Retrieved March 30, 2019, from https://www.nursingworld.org/our-certifi cations/informatics-nurse/

Informatics Nursing board certifi cation (RN-BC) through the American Nurses Credentialing Center (ANCC)

Certifi ed Professional in Healthcare Information Management Systems (CPHIMS) through the Healthcare Information and Management Systems Society (HIMSS)

Th e OJNA Journal - Page 16

NURSES TO KNOW

Adam Sragg, RNNursing Role: Circulating Nurse in OR

What is your nursing background? Degrees/credentials?I received my BSN from University of Maryland School of Nursing.

Was this your fi rst choice job? What led you to choose this posi-tion? How long have you been working in your fi eld?Th is job was not my fi rst choice, but it has worked out well and has been a great experience as a new graduate. I applied to many nurs-ing jobs and surgical nursing worked out best for my personal life and the ability to observe Shabbos. Th is is my fi rst job out of school and I have been working for two years.

Where do you currently work?I work as a circulating nurse in the operating room (OR) at Wash-ington Adventist Hospital in Takoma Park, Maryland.

What are your responsibilities?I perform patient safety roles, including proper sterile technique for Foley catheter insertion and skin preparation for procedures. I am responsible for correct patient positions, confi rming patient name, verifying expiration dates of medications, and assisting anesthesia in safe airway placement during endotracheal intubation and ex-tubation. I also perform thorough patient interviews, including medical history reviews to ensure preparation for surgery with no contraindications.

What is your favorite part about your job? Any specifi c highlight you would like to share?I enjoy serving as a patient/family advocate and liaison to commu-nicate pertinent information or questions throughout the periop-erative experience. I try to foster exceptional patient/family experi-ences through establishing rapport and sense of trust. In addition, I work in a large variety of surgical specialties, such as vascular, neu-rology, urology, gynecology, orthopedic, podiatry, ophthalmology, plastic/cosmetic, otorhinolaryngology, gastroenterology, cardio-thoracic, and pulmonology. Th is helps me build a nurse-to-patient relationship in many diff erent patient populations.Th ere are times where I get patients ready for surgery and I can tell they are nervous about the procedure. It is my job as the circulating nurse to make sure they feel as comfortable as possible. It is very humbling when I go in the OR and I fi nd my patient was wondering where I was and requesting me at his/her side before the surgery begins. I have had a couple of scenarios where unfortunately the patient went to the intensive care unit (ICU) aft er surgery. I like to follow up with these patients and visit them in the ICU. I fi nd it extremely rewarding when they remember me. It is gratifying to empower a patient and make sure they feel comfortable. It is not just a job to get them to surgery. Th e way I interact with them can make their experience positive overall.

Is there any special training or credentials required for your po-sition?We are required to have BLS and ACLS training and are encouraged to pursue our Certifi ed Nurse Operating Room (CNOR) license. I learned to scrub as part of my nine month training. I generally do not scrub-in unless they really need me and it is a minor procedure.

What do you do when you are not at work? Any tips on work/life balance?When I am not at work, I am busy with family. Outside of work, I incorporate the teamwork I learned as a nurse. Whether it means helping my family, personal needs, or community, I try to balance teamwork in my life. Working together with a spouse, family mem-ber, or friend has helped me balance my life’s needs. In addition, I am about to start a program for Family Nurse Practitioner.

How did you hear of/get involved with the OJNA?My family friend Sarah Bracha Cohen reached out to me about join-ing OJNA.

Please describe your experience being a male nurse in a predomi-nantly female profession.In most areas that I work in, I have been respected by my female colleagues. However, something which I have noticed as a male nurse is the expectation to further my degree and career goals. Whether at work or in my community, people expect that a male nurse will do more in nursing and not stop at the bachelor level. I personally would like to further my degree, but it is important to know there seems to be this male expectation that male nurses may be confronted with.

If you would like to be profi led in future issues of The OJNA Journal, send a short paragraph detailing your background and role to OJNAjournal@gmail.com.

Th e OJNA Journal - Page 17

CAREERS TO CONSIDER

Registered Nurse First Assist (RNFA)Tamar Yehudis Frenkel, BSN, RN

Job title Registered Nurse First Assist (RNFA)

Job Description According to the Association of periOperative Registered Nurses (AORN), an RNFA is a peri-operative nurse whose role is expanded. They work under the direction of a surgeon, in col-laboration with the other members of the medical team.

• Preoperatively, the RNFA ensures the operating room is set up, does a thorough chart review of the patient, performs focused nursing assessments, and collaborates in the patient’s plan of care.

• Intraoperatively, the RNFA performs surgical fi rst assistant techniques, including making incisions and manipulating tissue, using proper instruments and medical devices, provid-ing hemostasis, suturing, and providing wound management under the supervision of the surgeon. Most importantly, the RNFA does not work as a scrub nurse during the same case.

• Postoperatively the RNFA may make rounds independently or with the surgeon, as well as assist with patient discharge planning.

Educational Requirements [1,3]

• Active registered nurse (RN) license, certifi ed nurse operating room (CNOR), and comple-tion of the RNFA coursework, regulated by AORN.

• With an advanced practice license, such as a nurse practitioner, CNOR is not required.

• A bachelor’s degree is required for RNFAs practicing after January 1, 2020.

• To become a certifi ed RNFA, an additional 2,000 hours of experience working as an RNFA, as well as a bachelor’s degree, is required.

Recommended experience [3]

At least two years working in perioperative nursing.

Salary [3] This is a unique job, so specifi c salary information is limited. According to payscale.com, the average yearly salary is $73,507-$105,139.

Work environment [1] Perioperative

Job Outlook [3] As the number of ambulatory surgery/same-day centers grows, the need for RNFAs will in-crease as well.

Suggested Skills [1,4] Dexterity, fi ne motor skills, and visual acuity are all needed to provide surgical assistance. In addition, hand-eye coordination and critical thinking is essential.

References:[1] Association of periOperative Registered Nurses. (2018). AORN position statement on RN fi rst assistants (9th ed). Retrieved from https://www.aorn.org/-/media/aorn/guidelines/position-statements/aorn_position_statement_rnfa.pdf?la=en&hash=3A2D31A5305AF3990370972D4A7C34CC[2] Smith, J. D. (2017). What’s it like to be an RN fi rst assistant in surgery? Retrieved from https://www.medscape.com/viewarti-cle/882840[3] Colduvell, C. (n.d.). Career guide: Registered nurse fi rst assistant (RNFA). Retrieved March 1, 2019, from https://nurse.org/re-

sources/rnfa-career-guide/[4] Association of periOperative Registered Nurses. (2013). Th e RN First Assistant (RNFA) Standards of Practice (3rd ed). Retrieved from https://www.aorn.org/-/media/aorn/guidelines/rnfa/rnfa-standards-of-practice.pdf?la=en&hash=15D19105787881D4A53B4480521F6F3E

Additional resources:https://www.aorn.org/guidelines/clinical-resources/rn-fi rst-assistant-resources

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Th e OJNA Journal - Page 18

I’m not certain why. Maybe it’s because I’m a man. Maybe it’s because I’m in my mid-forties. Maybe it’s because I always wear a suit and tie. But, I can tell you that from the day I decided to become a nurse, I have fi elded the following cynical question countless times: “So, do you re-ally want to change people’s diapers for a living?”

Of course, as an ambitious and competitive stu-dent I had my answers. At fi rst I played the Alpha-bet Game: No, you don’t get it! You’re confusing my role with that of the CNA (certifi ed nursing assistant) or maybe even the LVN/LPN (licensed vocational/practical nurse). But I’m going to be a real professional! I’m going to be an RN (regis-tered nurse), maybe even someday an NP (nurse practitioner) or a CRNA (certifi ed nurse-anes-thetist)! But you know, once you start playing the Alphabet Game, you lose people at ABC.

When I started nursing school itself, all of a sud-den I had a whole new vocabulary: You’re talk-ing about changing diapers? Ugh! You are so task-oriented! Nursing is about critical thinking, therapeutic communication, patient education; we’re at the nexus of care between physicians and families, therapists and caseworkers.

And of course it’s all true—I am still blown away by how consistently smart and competent the nurses I’ve worked with have been. And yet

these “answers” somehow left me dissatisfi ed. Th ere was something niggling at me that I could not quite put my fi nger on.Until about six months ago.Th ere I was, about a month or so into my ad-vanced med-surg rotation. Th e patient: A 64-year-old male with a cirrhotic liver and he-patic encephalopathy, who is altered, labile, and grumpy. We’re administering Lactulose to bring down his ammonia level to help him start think-ing straight again. But that stuff makes you go!“Student nurse! Th is one’s a good patient for you.” Th e patient is pungent with body odor as it is, and now I have to walk him to the bathroom, stand with him as he relieves himself, and clean him when he’s done. Th at question started to play again in my mind. Is this really what I want to do for a living?Th at’s when I was brought back to a teaching I had shared with my students in my Judaic stud-ies class years ago. Th inking of it at that moment helped me clarify my purpose then, and I think it bears sharing now.Towards the beginning of the Book of Exodus a story is recounted. It tells of Pharaoh’s decree to have every newborn Jewish male thrown into

the Nile to die. Two heroines, the Israelite midwives, Shifra and Pu’ah, risk their own lives to defy the decree and successfully rescue countless others.According to Jewish tradition, Biblical names always convey es-sence; they some-how capture and express the core identity of the person or thing so named. According to Talmudic tradi-tion, the names of these heroines are actually honorifi cs conferred in trib-ute to their great work and self-sacrifi ce, as if to say that these acts were transforma-tive experiences that redefi ned the very essence of who these women

were.

But what do these names actually mean? Th e Talmud states that Shifra means “one who beau-tifi es” because she would cleanse and beautify the baby when he was born; Pu’ah means “one who soothes” because she would soothe the cry-ing newborn with comforting song.

Now, as special as those acts of care may actu-ally be, this statement really begs two important questions:

1. Are those really the best ways we can de-scribe their acts of heroism? Th ese women saved lives—and risked their own to do so. Shouldn’t they be called names that refl ect the magnitude of their deeds: “Rescuer,” “Savior,” “Risk-Taker”?

2. Cooing to a crying baby and cleaning a newborn child from amniotic fl uid are things any caregiver would do. We might even call it negligence to withhold such care. So how is it that these mundane acts are identifi ed as singularly noble and trans-formative?

Rabbi Yerucham Levovitz, one of the great Jewish ethicists of the 20th century, off ers this simple, yet profound, answer: Th ere is, in fact, no such deed that is inherently momentous or inconsequential. It is, rather, the investment, the presence, of the person in that act which gives it its transformative power.

Shifra and Pu’ah acquired new essence, they be-came qualitatively diff erent people, by the devo-tion, love, and nurturing that they were able to squeeze into their seemingly mundane acts of daily care for others in vulnerable circumstances.

Back to that moment at the bedside. Yes, I can get trapped in the pettiness of being repulsed by fi lth. I can be annoyed by undeserved complaints.

But I can also appreciate this man’s suff ering. I can help shoulder his burden. If I get it right, I can preserve his dignity amidst degradation. I can restore some of his humanity. If I can tran-scend my smallness; I can become a little bit of a diff erent person today.

Th at’s really the mission of the nurse. Yes, that’s really what I want to try to do every day.Rabbi Yonah Solomon, BSN, RN, PHN, is completing his nursing residency in a medical-surgical/oncology unit at Providence St. Joseph Medical Center in Bur-bank, California, and is beginning additional oncology training toward earning his chemotherapy certifi cation. He earned his nursing degree in December 2017 from California State University, Northridge (CSUN) follow-ing a 14-year career as a seventh grade rebbe and high school limudei kodesh teacher. R’ Yonah lives in Los An-geles (Valley Village) with his wife and eight children, and tries his best to still make it out most nights to learn and teach in the local night kollel. He can be reached at nurseyonah@gmail.com.

MUSINGS

Transcending the SmallnessYonah Solomon, BSN, RN, PHN

WWW.CSAUCY.COM@C.SAUCY.SCRUBS

Th e OJNA Journal - Page 19

Th e Shift : One Nurse, Twelve Hours, Four Patients’ Lives is a memoir by Th eresa Brown about the challenging ride of caring for four patients on an oncology unit during one 12-hour shift . Th is book highlights the oft en-unspoken realities of life and death while working in a hospital as an Eng-lish university professor-turned registered nurse.

Brown shares how it feels to start a shift with three patients, knowing that an admission could be rolling into her unit. She shows the reader how she constantly reprioritizes tasks throughout her shift . It is easy for the reader to imagine him/herself being in similar situations and handling compa-rable scenarios on any unit, making this book relatable to the majority of bedside nurses.

Brown has a compassionate yet authentic approach to nursing and the way that she cares for patients. Nurses oft en worry about whether their physical assessments are accurate or not and if they “missed” something. Nurses may also feel defeated if they cannot fi gure out what is wrong with their patients, despite completing a thorough assessment and doing ev-erything right. When Brown auscultates her patient’s bowel sounds using the all too common yellow disposable “toy” stethoscope and hears noth-ing, she knows that something is not right with her patient, yet she fails to deduce that her patient is in fact having a medical emergency. Brown sends the patient to get a CT scan of her abdomen, to fi nd out that the patient had a perforation. She describes her disappointment at not having seen the signs of a bowel perforation and she kicks herself because of that. Readers will feel relieved in noticing that they are not alone in second guessing their judgements and assessments.

Any nurse will appreciate this book, especially if he/she is a bedside or oncology nurse. Nurses come home from their shift s feeling exhausted and drained, and there are times when they feel that there is no one who can com-prehend the stressors and rigors of the daily routines of their jobs. Th is book shows its readers that they are not alone and that there are other nurses who experience similar situations.

Interestingly, this book is also a great read for patients because it demon-strates that nurses are truly watching over them throughout their entire shift . Th is also shows patients that nurses have an overwhelming amount of tasks that must be properly prioritized throughout the day, and while the nurse might tell the patient that she will get them some water, or a new shower curtain like Brown did, there are oft en other tasks that must be done fi rst. Th is is sure to be an eye opener for patients.

All in all, Th eresa Brown reminds us that it is truly a privilege for us to do what we do. While this book talks about Brown’s shift and her personal story, it contains many elements of all nurses’ experiences.

OJNA RECOMMENDS: BOOK REVIEW

The Shift: One Nurse, Twelve Hours, Four Patients’ Lives Book Author: Theresa BrownReviewer: Yehudis Appel, BSN, RN

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Th e OJNA Journal - Page 20

I always knew I was going to be in the medical fi eld. I was the kid who couldn’t look away when my pediatrician drew blood at the offi ce. At eight years old, I had my dentist tape a mirror to the overhead procedure lamp so I could see my own root canal taking place. When I was 10 and needed stitches under my eye from a boomerang accident, my mom held the mirror steady so I could watch.

When I fi rst became an emergency medical technician (EMT), I thought the next logical step for me would be to attend medical school. I spent thousands of hours on the ambulance, providing care to patients in emer-gency situations and transporting to various emergency departments.

As I spent more time in hospitals, my experiences grew and my percep-tions evolved. I realized that the role I wanted to fulfi ll was not that of a doctor; it was at the bedside, providing direct bedside care. Th e phy-sicians’ role at a hospital is vital to the patient, but it was not where I wanted to be. Nursing, direct patient care, was calling to me.

Nurses spend time with their patients. Th ey explain what each medica-tion is for, and actually administer them. Th ey give injections, start IV lines, and remove them as necessary. Nurses get the patients out of bed, prep them for surgery, and help them deal with the aft ermath of terrible diagnoses. Th ey help families adjust to new medical devices. In the worst of cases, they explain cause of death to a family in a manner that shows that this case was not just a number or a diagnosis, but a person who mattered to them.

I started nursing school, and was not shocked to learn that I was not only the only religious Jew, but the only religious Jewish male! Nine out of 10 nursing students are female, and even fewer of the males are Jewish. I wear a yarmulke proudly, and I ask a lot of questions. Suffi ce it to say, I stood out.

I was hired at a prestigious institution in a stepdown unit for patients undergoing cardiothoracic surgery. Th e training was intense, and I learned a lot in a very short time. Aft er a few months, I was moved to the cardiothoracic intensive care unit (CTICU). My colleagues were excel-lent, and I was happy to learn from them as well. I learned about oth-er cultures, and my experiences and understanding grew and evolved.

One of the aspects I love most about being a nurse is the impact that we can have on each other, especially in such a fragile setting. A hand on a

shoulder or the right tone of understanding can mean so much to a pa-tient or family member. When they see how much we really care, when they see that we really want to make them feel better, the rest of their stay can be so much more bearable. Nurses make an unequivocal diff erence.

A short while ago, I was assigned a female patient who was in end stage heart failure. She had been waiting for a heart transplant and could wait no longer. In the interim, she was evaluated and approved as a candidate for a left ventricular assist device (LVAD), a mechani-cal pump that is worn by the patient on a harness or belt and allows blood to circulate through the body. It is an amazing piece of tech-nology which saves lives daily, and I get to teach patients to man-age the care of it, as well as how to live with this device at home.

Th is particular woman was a religious Muslim who spoke only Arabic. She refused interpretive services and would only allow her son to trans-late for her. Her son said that she never learned any English at all. As her son explained to me, she would not touch a man who was not her husband, brother, father, or son. I responded that I would be as delicate as possible to minimize physical contact, but that her care would be my priority. I would still need to check her blood pressure and listen to her lungs, but would do so as carefully as possible. He said he understood, and aft er a brief conversation with her, he told me that she was happy with this arrangement.

Because of her medical condition prior to surgery, she had a central line access, which required her to be washed from head to toe daily with a strong antimicrobial solution to lower bodily surface bacteria, and mini-mize her chance of infection.

When it was time for her wash up, I could see how uncomfortable she was. She nodded OK, but her face told me she was about to cry. I asked to her to wait a moment. I stepped outside the room and asked a fe-male nurse who was available to take this aspect of care over for me, and meanwhile I would take care of what her patients needed. Th e arrangement worked out well, and my patient looked happy about this. Her relief was obvious, and I was satisfi ed that today was a win.

Th e next day, I was given the same patient, and again, she was sched-uled for a wash up. Today, however, was diff erent. Today was sur-gery day. I could see at the beginning of the shift how nervous she was about the upcoming procedure. Her son asked many ques-tions on her behalf, and though we went over the plan again and again, the apprehension was palpable. When it came time to be washed up, I once again was able to have a female nurse take care of it while I “traded” and took over tasks for the other nurse’s patients.

Six a.m. arrived and suddenly it was go-time. Th e operating room called our unit and said they were ready. A wheelchair was brought to her room and she got into it. I bent over a bit so we were eye level. I looked her in the eye, and with her son interpreting, I told her that I wished her luck and hoped that the surgery went well. As the wheel-chair passed me, she motioned for the patient transporter to stop. She grabbed my arm, pulled me in for a hug, and with tears on her cheeks, said the only English words I ever heard her from her: “Th ank you.” Nursing is where it’s at for me.

Yaakov Shereshevky is cardiovascular certifi ed RN at NYU Langone Medi-cal Center in New York, where he has worked for the last 3 years. His previ-ous experience includes 10 years of working with children with autism in a group home setting. In his spare time, he teaches CPR and volunteers as an EMT in his local chapter of Chevra Hatzalah of Canarsie/Mill Basin.

MUSINGS

Nursing is Where It’s AtYaakov Shereshevsky, RN

Th e OJNA Journal - Page 21

Get Into the Rhythm: EKG PrimerAlexander Kushnir, MD, PhD

Stroke: The Changing World of Treatment and PreventionSteven Rudolph, MD

Drama-Free Shifts: Interactive Conflict Resolution WorkshopOmar Morgan

Picky Eaters: Nutritional Challenges in the Neonatal PopulationHelen Towers, MD

When the NICU is Your Nursery: A Father’s Journey Moshe Krakowski

Shift Work: Navigating Family, Intimacy, and Taharas HamishpachaToby Carrey, MSW

Still a Long Way to Go: Mental Health Stigma in Our Communities David Pelcovitz, PhD

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Th e OJNA Journal - Page 22

Some days I hate the sounds of the machinery at my job. Th e feeding pumps whistle. Th e intercom dings. Th e pagers trill. Th e IV pumps beep loudly and insistently no matter how many times I push their buttons, straighten patient’s arms, and re-prime their tubing. On particularly bad days, I will sit at the nursing station and cover my ears with my hands for a minute or two, just for a short break from the cacophony. Still worse, is the sound of the people who are suff ering. Confused patients ask when they can go home. Patients with delirium beg for help and release. Patients with advanced dementia shriek and moan. It’s a veritable orchestra, each musi-cian blending together in a symphony of human misery.

When I started out in nursing, it would drive me insane and sometimes to tears. How could I avoid it, when there were people crying out for succor and I was unable to provide enough to make everything all better? How could I reason with someone who was delirious and confused when he tried to yank out his IVs and Foley catheter in order to totter, on unsteady feet, towards the exit? What was I to say to someone with dementia who asked, for the twentieth time that hour, where she was and she was there? What did I say to the person that I had to put in restraints so that he did not hit me or the other nurses?

I still have not totally fi gured it out. I can try to distract with TV and radio. I can put someone in a wheelchair with a restrictive tray up at the nursing station so that the whole team can guard him or her. I can dole out pain medication and sedatives and even discuss with the doctor about obtain-ing a better management regimen. Th ere is only so much I can do. I wish I could do more.

Th anks to experience and the wisdom of senior nurses, I am better at man-aging the human misery now. I am able to stay calm when telling Betsy for the twenty-fi rst time that she is in the hospital and that no, she cannot leave just yet. I have learned to do what I can for Rosa screaming with dementia, giving out pain medication and dimming the room and provid-ing a nice warm blanket to help her settle. I have learned that my safety is more important than freedom for Benny’s fi sts. Perhaps most im-portantly, I have learned to sometimes block out the music when I need to concentrate on something else. But then I won-der, have I become better at working alongside the symphony around me? Or have I become a worse person, able to ignore it? I’m sure some visitors are worried when they see nurses laughing at a joke at the nursing station when a patient is visibly upset only a few meters away.

A mentor of mine once told me that a good nurse is a nurse who is afraid that she might harm patients through her ig-norance, because that nurse will stay on her toes and constantly observe and reas-sess and ask questions. She is overall a very safe nurse for that patient. Is it similar for a nurse who, though he works with the orchestra playing in the background, never forgets that it is there? He is working hard, but never forgets why he originally went into nursing: to make people feel better, to turn the tempestuous symphony of misery into a glorious over-ture of health and wellness.

Th e symphony continues playing, and the orchestra doesn’t go away. Th e musicians may continue to have pain, and mental anguish and dementia. Th ey direct dis-

cordant angry sounds towards the nurses who are just trying to help. And while there is only so much I can do to adjust the volume, I also know how to work to its rhythm. I hope that I always remember that while I may be unable to silence the orchestra of human misery, I can always do my best to keep the volume down.

Julie Rubenstein, RN, BScN(Imm), graduated from the University of Ot-tawa School of Nursing (Canada) in 2015. Since then she has worked in palliative care, home health and geriatrics, and is currently employed as a fl oor nurse on a general medicine unit. Her professional interests include chronic disease management, patient teaching, patient advocacy, and men-toring new nurses. When not working or reading up on tests and treat-ments, Julie enjoys reading, cooking, knitting, and snowshoeing in the win-ter. She lives in Toronto, Canada. She doesn't think there is enough snow there in the winter.

MUSINGS

Working Alongside the Symphony OrchestraTova Julie Rubinstein, RN, BScN

Th e OJNA Journal - Page 23

OJNA NEWS

In the last 18 months, OJNA has grown in membership, expanded member resources and services, and held multiple social and educational events.

Effective February 19, 2019, Blima Marcus has stepped down from her position as OJNA President to pursue other professional projects. We thank Blima for her time serving as the President of OJNA. We wish her luck in her future endeavors. Elisheva Rosner, Vice President, has assumed the role of President of OJNA.

Effective May 5, 2019, Toby Bressler PhD, RN, OCN has joined the Executive Board as Vice President. Toby's appointment will restore the Board to its full complement of four members.

Toby is currently the Director of Nursing for Oncology and Clinical Quality at Mt. Sinai Health System in New York and is an Assistant Professor of hematology and oncology at Icahn School of Medicine. Prior to functioning in these roles, Toby has held many nursing leadership positions, taught at various nursing schools, and received numerous nursing leadership awards.

Please join us in welcoming Toby to the OJNA leadership team!

Elections for Secretary and Treasurer positions will take place on December 1, 2019. Nomi-nations should be submitted by November 1, 2019. OJNA members who have active, paid membership for at least six consecutive months prior to elections will be eligible to vote.

Board members commit to stay in their position for two years.

Qualifi cations to join as a board member:

• Active RN license

• Bachelor's degree in Nursing; Masters or Doctorate preferred

• Leadership experience

• Active paying member of the OJNA for at least 6 months

Do you remember the feeling of being a new nurse? OJNA is looking to expand its team of mentors for its new grad mentorship pro-gram. Mentors work with mentees for about six months and ease their tran-sition into the world of nursing. Please email ojnamentor@gmail.com if you are interested.

Call for Resume ExpertsDo you have experience in HR or as a manager? Join our team of resume reviewersand assist us in reviewing resumes for OJNA members. Email ojnamentor@gmail.com if you are interested.

Continuing Education We have 50 continuing education modules on our website - all free for paying members!

Recently added to our website:• The Role Of The Intestinal Microbiota In Necrotizing

Enterocolitis And Neonatal Sepsis

• Wound Healing And Nutritional Management

• Dietitians Leading Innovation: Using Data For Quality Improvement And Patient-Focused Transitions Of Care

• Open Wide: Broadening the NP Role

• Care Coordination: Children with Medical Complexity

• A Mentorship Program for New Graduate Nurses

• Teen and Intimate Partner Violence Screening

• Utilizing Continuous Glucose Monitoring Data To Improve Diabetes Care

OJNA BOARD LEADERSHIP UPDATES

The board members of OJNA have been focusing on chapter development, creation of an advanced practice nursing committee, and organizational growth and development.

OJNA CHAPTERS

In the last few months, OJNA chap-ters across the United States have hosted events where nurses came to enjoy each others’ company, net-work, and learn. We have held events in Florida, Ohio, Michigan, Illinois, Pennsylvania, and Maryland. If you would like to be involved in develop-ing a chapter in your region, please email us at OJNAboard@gmail.com. The OJNA assists chapters with event planning, fi nancial assistance, publicity, and more.

VACCINE EDUCATION

In response to the current measles outbreak centered in Orthodox Jewish communities in the New York area, a group of OJNA nurses developed the Vaccine Task Force that aimed to address vaccine hesitancy and misinformation related to vaccine safety. The group provided evidence-based vaccine education to groups of women in intimate settings and worked on the development of a professional educational publication for widespread dissemination. The work of these OJNA nurses garnered much positive media attention and their work has been featured in many media outlets to include The New Yorker, CBS Good Morning, the BBC and more. As the work of the Vaccine Task Force continued to develop, their scope grew beyond the OJNA umbrella and as such their work will now be continued under the auspices of the EMES Initiative under the leadership of former OJNA president Blima Marcus. We encourage all OJNA nurses to continue to support this important endeavor.

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Blima Marcus, DNP, ANP-BC, RN, OCN received her Bachelor of Science in Nursing from the New York University Rory Meyers Col-lege of Nursing and received her Doctorate in Nursing Practice in adult primary care from the Hunter-Bellevue School of Nursing in January 2018. She is an inpatient nurse practitioner at the Memorial Sloan Kettering Cancer Center and an Adjunct Assistant Professor

at the Hunter-Bellevue School of Nursing. She has been published in the American Journal of Nursing and in the Forward. She is a member of Sigma Th eta Tau Inter-national Honor Society of Nursing, Oncology Nursing Society, and the American Cannabis Nurses Association. She lives in Brooklyn, New York, with her husband and two children.

Tobi Ash, MBA, BSN, RN, received her Bachelor of Science in Nursing from Barry University in 1998, her Masters in Business Administration from Nova Southeastern University in 2001, and is currently completing her Ph.D. at Walden University. Tobi is the Di-rector of Women’s Health Care at Nano Health Associates in Miami Beach, Florida. Tobi has more than 20 years of experience working with families, with an emphasis on women's health. She is a mem-

ber of Sigma Th eta Tau International Honor Society of Nursing and served on the Health Care Advisory Committee for the City of Miami Beach for two consecutive terms. She lives in Miami.

Batsheva L. Bane, CNM, MSN, RNC, CBC, recently graduated from Frontier Nursing University with a Master of Science in Nurse Midwifery, aft er working as a Registered Nurse in neonatal criti-cal care and postpartum care units. She is practicing as a Certifi ed Nurse Midwife at Jersey City Medical Center while pursuing her Doctorate of Nursing Practice. She is a member of the American

College of Nurse Midwives, the New York State Association of Licensed Midwives, Sigma Th eta Tau International Nursing Society, and Tau Sigma Nursing Society, and OJNA. She lives in Clift on, New Jersey, with her husband and children.

Sarah Bracha Cohen, MS, RN, received her Bachelor of Arts in Health Sciences from Hebrew Th eological College and her Master of Science in Nursing and Clinical Nurse Leader (CNL) from the University of Maryland School of Nursing in December 2017. She is a member of Sigma Th eta Tau International Honor Society of Nursing, Th e Honor Society of Phi Kappa Phi, and the American

Nurses Association.. In addition to her work for the OJNA Journal, she works as a doula, is an editor and contributing writer for a local Jewish newspaper, and is a post anesthesia care unit (PACU) nurse at NYU Langone in Manhattan.

Tamar Yehudis (Tami) Frenkel, BSN, RN, received her Associate’s Degree in Nursing from Phillips Beth Israel School of Nursing in 2011 and her Bachelor of Science in Nursing from Chamberlain University in 2014. She started her career working at a clinic for pe-diatric Allergy and Immunology, and now currently works at Mai-monides Medical Center in Brooklyn as a medical-surgical nurse.

Shaindy (Shari) Lapides BN, RN, received her Bachelor of Nursing from McGill University and her RN from Dawson College in Mon-treal, Canada. She has worked with children with visual, motor, and hearing impairments. She works as a Clinical Evaluation Manager at Visiting Nurse Service of New York where she completes Uniform Assessment System for NY State. She lives in Manhattan with her

husband and baby.

Tziporah Newman, BSN, RN, received her Associate Degree in Nursing from Middlesex County College and Bachelor of Science in Nursing from Th omas Edison State College. She currently works as a fi eld nurse with medically fragile children. She recently took on the additional role as Nurse Supervisor. She previously worked as a Director of Nursing for a home health care agency, supervising and

teaching nurses and home health aides. She is a member of the American Nurses Association, the New Jersey State Nurses Association, and the Society of Pediatric Nurses. She actively volunteers for Chai Lifeline and her local Bikur Cholim

Orthodox Jewish Nurses Association Inc.411 Hempstead Turnpike, Suite 200West Hempstead, NY 11552

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